Quaker_SEAF Short Environmental Assessment Form
Part I -Project Information
Instructions for Completinu
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency; attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Project:
Fastrac Cafe Quaker Road
Project Location(describe, and attach a location map):
773 Quaker Road(at Dix Avenue),Town of Queensbury,Warren County
Brief Description of Proposed Action:
The project includes the construction of a 5,800+/-square-foot,single story convenience store and two fuel dispenser canopies(one regular
fuel and one diesel).The new convenience store includes food service(similar to a sandwich shop)with indoor/outdoor seating and a
drive-thru. Eight fuel dispensers for 16 vehicles will be constructed under the main canopy and three diesel dispensers for six trucks will be
located at the rear of the site. Both canopies will be served by underground storage tanks holding approximately 40,000 gallons of petroleum
products.The site will have two points of access:a full-access driveway on Dix Avenue(Route 42)and a full access driveway that extends off
of Quaker Road from the West side of the site. Other provisions for the proposed project are 31 parking spaces,a dumpster enclosure,a drive
thru lane,sewer treatment facilities,and landscaped areas.
Name of Applicant or Sponsor: Telephone: 315-552-6800 x2124
Fastrac Markets LLC,Brett Hughes E-Mail: BHughes@fastracmarkets.com
Address:
6500 New Venture Gear Drive
City/PO: State: Zip Code:
East Syracuse NY 13057
1. Does the proposed action only involve the legislative adoption of a plan,local law, ordinance, NO YES
administrative rule, or regulation?
If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that Z ❑
may be affected in the municipality and proceed to Part 2. If no, continue to question 2.
2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval: 1:1 ❑
Town of Queensbury Planning Board,Town of Queensbury Zoning Board of Appeals, NYSDEC, DOH,Warren County DOT
3.a. Total acreage of the site of the proposed action? 7.23 acres
b. Total acreage to be physically disturbed? 6.00 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 7.23 acres
4. Check all land uses that occur on, adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) [—]Industrial mCommercial ❑Residential(suburban)
❑Forest ❑Agriculture ❑Aquatic El Other(specify):
❑Parkland
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5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations? ❑ ✓❑ ❑
b. Consistent with the adopted comprehensive plan? ❑ ❑ ❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑ ✓❑
7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NO YES
If Yes,identify: ❑
8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES
❑✓ F-1-
b.
b.Are public transportation service(s) available at or near the site of the proposed action? ❑✓ F-1-
c.
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑✓ ❑
9. Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies: El F71
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: ❑ ✓❑
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: ❑✓ ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? ❑ ✓❑
b. Is the proposed action located in an archeological sensitive area? ❑ ✓❑
13. a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal, state or local agency? ❑✓ ❑
b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? ❑ ❑
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:
❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland m Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? ❑ ❑
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge, either from point or non-point sources? NO YES
If Yes,
a. Will storm water discharges flow to adjacent properties? [Z]NO EJYES ❑ ✓❑
b.Will storm water discharges be directed to established conveyance systems runoff and storm drains)?
If Yes,briefly describe: NO ❑YES
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I8. Does the proposed action include Construction or other activities that result in the inipotindinent of R-0—
water or other lipids(c.g. retention pond,waste lagoon,dam)?
If Yes,explain purpose and sim ...................... ...........
............. ........................................ Z El
L--J
.................. . ... ...
.......... ...... ..........
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe:
..........
I
.......... ........................................ ................
20. Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO VES
completed) for hazardoLis waste'?
If Yes,describe:
0
............ ............... ............
................
........... ................................
I AFFIRM THAT THE INFORMAJ NPROVIDEWABOVE ISTRWAND ACCURATE TO THE BEST OFMY
KNOWLEDGE
0
Applicant/spon iname. ................................................. Date:
Sig, /Q
.............. ........
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Agency Use Only [If applicable]
Project:
Date:
Short Environmental Assessment Form
Part 2 -Impact Assessment
Part 2 is to be completed by the Lead Agency.
Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by
the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by
the concept"Have my responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ Elregulations?
2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑
3. Will the proposed action impair the character or quality of the existing community? ❑ ❑
4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing: El a.public/private water supplies?
b.public/private wastewater treatment utilities? ❑ ❑
8. Will the proposed action impair the character or quality of important historic, archaeological, El architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, El waterbodies,groundwater, air quality, flora and fauna)?
10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage El problems?
11. Will the proposed action create a hazard to environmental resources or human health? ❑ ❑
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Agency Use Only[If applicable]
Project:
Date:
Short Environmental Assessment Form
Part 3 Determination of Significance
For every question in Part 2 that was answered"moderate to large impact may occur", or if there is a need to explain why a
particular element of the proposed action may or will not result in a significant adverse environmental impact,please
complete Part 3.Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that
have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency
determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,
probability of occurring,duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-
term,long-term and cumulative impacts.
Check this box if you have determined,based on the information and analysis above, and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
Check this box if you have determined,based on the information and analysis above, and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Name of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
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